diagnostics for DKA (5)
plasma glucose > 250 but < 800 arterial pH < 7.3 bicarb < 19 increase anion gap positive ketones
Whipple triad and use
symptoms consistent w/ hypoglycemia
low plasma glucose concentrations when symptoms are present
relief of sx when glucose level rises
diagnosis of hypoglycema w/o diabetes
DKA treatment orders (4)
correct fluid loss
correct electrolytes (especially K+)
correct hyperglycemia w/ insulin
correct acid base balance
discharge for DKA
only after stable on outpt insulin
wait 24h after glucose, anion gap, & pH are normal
hyperosmolar hyperglycemic nonketotic state diagnostics (5)
plasma glucose > 600 bicarb > 18 serum osmo > 320 variable anion gap small serum ketones
tx for hyperosmolar hyperglycemic nonketotic state (3)
infuse isotonic saline
correct K+ deficit
low dose IV insulin
alcoholic ketoacidosis diagnostics (4)
pH < 7.3
increased serum osmo
anion gap > 14
+ serum ketones
alcoholic ketoacidosis treatments (2)
insulin or IV dextrose
thyroid storm tx (2)
beta blocker
PTU
myxedema coma tx (3)
IV Liothyronine (T3) IV Levothyroxine (T4) hydrocortisone
hypocalcemia labs
Calcium < 7.5 mg/dl
correct for albumin: measured total Ca + 0.8(serum albumin)
hypocalcemia tx (3)
IV Magnesium
IV calcium
Vit D
tx hypercalcemia (2)
IV NS
IV bisphosphonate
tx adrenal crisis (3)
NS or D5NS
4 mg dexamethasone IV bolus
ACTH stimulation test to confirm diagnosis
tx pituitary apoplexy (3)
high dose steroids
correct electrolytes & glucose
consider surgical decompression of tumor
insulin secretagogues OD tx
resuscitate, discharge once safe
test for diagnosing insulin secretagogue OD
positive insulin stimulation test
postprandial hypoglycemia test?
mixed meal test
paresthesias, carpopedal spasm, tetanic seizures, positive Chvostek and Trousseau’s signs, increased QT interval, bradycardia
hypocalcemia
